Healthcare Provider Details

I. General information

NPI: 1629393632
Provider Name (Legal Business Name): OLUYEMISI OLAYINKA ADEDOTUN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 E FLAMINGO RD STE 100
LAS VEGAS NV
89121-5018
US

IV. Provider business mailing address

3430 E FLAMINGO RD STE 100
LAS VEGAS NV
89121-5018
US

V. Phone/Fax

Practice location:
  • Phone: 702-444-4690
  • Fax: 702-444-0977
Mailing address:
  • Phone: 702-444-4690
  • Fax: 702-444-0977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number26NJ00276700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License Number26NJ00276700
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN001368
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: